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01.09.2013 | Ausgabe 9/2013

Surgical Endoscopy 9/2013

Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan

Zeitschrift:
Surgical Endoscopy > Ausgabe 9/2013
Autoren:
Takeshi Nakajima, Yutaka Saito, Shinji Tanaka, Hiroyasu Iishi, Shin-ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yuusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisasbe, Takahisa Matsuda, Hideki Ishikawa, Ken-ichi Sugihara
Wichtige Hinweise
This study was reported at the United European Gastroenterology Week held at Stockholm, Sweden, October 24, 2011.
This study was conducted on behalf of the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. The working group that participated in this study are listed in “Appendix”.

Abstract

Background

Conventional endoscopic resection (CER) for early colorectal neoplasia (CRN) is widely accepted as a minimally invasive treatment. Endoscopic submucosal dissection (ESD) was developed in Japan to resect larger lesions, but ESD was not covered by the Japanese national health insurance until April 2012. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs measuring ≥20 mm, we conducted a prospective multicenter study at 18 medium-volume and high-volume specialized facilities in cooperation with the Japan Society for Cancer of the Colon and Rectum (JSCCR).

Methods

The JSCCR conducted a multicenter, observational study of all patients treated by CER and ESD of CRNs measuring ≥20 mm.

Results

From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs (CERs 1,029; ESDs 816). Lesions diagnosed as protruded, flat, and depressed totaled 541, 1224, and 48, respectively. En bloc resection rates and mean procedure times for CER/ESD were 56.9 %/94.5 % (P < 0.01) and 18 ± 23 min/96 ± 69 min, respectively. The average ESD procedure time was 129 ± 83 min in the ≥40-mm group. As lesion size increased, the CER en bloc resection rate decreased significantly (trend P < 0.01), but the ESD en bloc resection rate remained over 93 %. Perforation and delayed bleeding rates of CER/ESD were 0.8 %/1.6 % (P < 0.05) and 2 %/2.2 % (P = 0.3), respectively.

Conclusions

The en bloc resection rate for ESD was significantly higher than for CER, although complication rates were fairly low. Despite a longer procedure time, safety of colorectal ESD has improved in various facilities in Japan. However, ESD for lesions measuring ≥40 mm must be performed by experienced endoscopists due to the longer procedure time.

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